症状性颈动脉和椎-基底动脉狭窄患者的阿司匹林和氯吡格雷抵抗现象  

Aspirin and clopidogrel resistance in patients with symptomatic carotid and vertebrobasilar artery stenosis

作　　者：刘芳[1] 刘加春[2] 王大明[2] 李金[1] 王利军[2] 刘燕[1] 

机构地区：[1]卫生部北京医院神经内科,100730 [2]卫生部北京医院神经外科,100730

出　　处：《中国脑血管病杂志》2008年第1期15-18,48,共5页Chinese Journal of Cerebrovascular Diseases

基　　金：卫生部临床学科重点项目(卫规财发[2001]321号);国家“十五”攻关项目(2004BA714B07)

摘　　要：目的观察症状性颈动脉和椎-基底动脉狭窄患者服用阿司匹林和氯吡格雷抵抗现象的发生情况。方法在54例症状性的颈动脉(25例)、椎动脉(19例)、颈动脉合并椎动脉(8例)以及基底动脉(2例)狭窄的患者中,有39例行择期支架置入术。采用二磷酸腺苷、肾上腺素、胶原和花生四烯酸为诱导剂,分别测定已服用阿司匹林(100mg/d)≥10d,以及随后加服氯吡格雷(75mg/d)≥5d患者的血小板聚集率。阿司匹林抵抗标准为单用阿司匹林时,以500μg/ml花生四烯酸诱导的血小板聚集率≥20%和5μmol/L二磷酸腺苷诱导的血小板聚集率≥70%。氯吡格雷抵抗标准为在阿司匹林基础上加用氯吡格雷前、后,5μmol/L二磷酸腺苷诱导血小板聚集率的差值≤10%。结果54例患者中,有9例(16.7%)存在阿司匹林抵抗,12例(22.2%)存在氯吡格雷抵抗,1例(1.8%)存在阿司匹林和氯吡格雷双抵抗。9例阿司匹林抵抗者加用氯吡格雷后有5例花生四烯酸诱导的聚集率降至<20%,有8例二磷酸腺苷诱导的聚集率降至<70%。1例支架置入术后支架内急性血栓形成为阿司匹林抵抗的患者。结论症状性颈动脉和椎-基底动脉狭窄患者中存在一定比例的阿司匹林或氯吡格雷抵抗现象,氯吡格雷与阿司匹林合用克服了部分阿司匹林抵抗现象。阿司匹林抵抗可能与支架置入术后血栓性并发症的增加有关。Objective To observe the occurrence of aspirin and clopidogrel resistance in patients with symptomatic carotid and vertebrobasilar artery stenosis. Methods The platelet aggregation rate was determined respectively in patients who had received aspirin 100 mg/d for≥ 10 days, and subsequently adding clopidogrel 75 mg/d for ≥ 5 days by using adenosine diphosphate, epinephrine, collagen and amchidonic acid as inducers in 54 patients with symptomatic carotid （ n = 5 ）, vertebral artery （ n = 19 ）, combined carotid and vertebral artery （ n = 8 ） as well as basilar artery （ n = 2 ） stenosis. The criteria of aspirin resistance was defined as 500 μg/mL arachidonic acid-induced platelet aggregation rate ≥20% and 5 μmol/L adenosine diphosphate-induced platelet aggregation rate ≥70% when treated with aspirin alone. The criteria of clopidogrel resistance was defined as the difference ≤ 10% of 5 μmol/L adenosine diphosphate-included platelet aggregation rate on the basis of aspirin before and after adding clopidogrel. Results Of the 54 patients, 9 （ 16.7% ） were aspirin resistant, 12 （22.2%） were clopidogrel resistant, and 1 （1.8%） was beth aspirin and clopidogrel resistant. In 5 of the 9 patients with aspirin resistance, arachidonic acid-induced platelet aggregation rate decreased to 〈 20%, and adenosine diphosphate-induced platelet aggregation rate in 8 patients decreased to 〈 70% after adding clopidogrel. Thirty-nine of the 54 patients underwent elective stent placement. Acute thrombosis occurred in stent in one patient with aspirin resistance after the procedure. Conclusion The phenomenon of aspirin or clopidogrel resistance exists in quite a proportion of patients with symptomatic carotid and vertebrobasilar artery stenosis. The combination of clopidogrel and aspirin have partially overcome aspirin resistance. Aspirin resistance may be associated with the increase of thrombotic complication after stenting.

关 键 词：颈动脉狭窄 椎底动脉供血不足 阿司匹林 氯吡格雷 抗药性 

分 类 号：R743.3[医药卫生—神经病学与精神病学]